Husna Razee

Listening to the rural health workers in Papua New Guinea – The social factors that influence their motivation to work

Despite rural health services being situated and integrated within communities in which people work and live, the complex interaction of the social environment on health worker motivation and performance in Low Middle Income Countries has been neglected in research. In this article we investigate how social factors impact on health worker motivation and performance in rural health services in Papua New Guinea (PNG). Face-to-face in-depth interviews were conducted with 33 health workers from three provinces (Central, Madang, and Milne Bay) in PNG between August and November 2009. They included health extension officers, community health workers and nursing officers, some of whom were in charge of the health centres. The health centres were a selection across church based, government and private enterprise health facilities. Qualitative analysis identified the key social factors impacting on health worker motivation and performance to be the local community context, gender roles and family related issues, safety and security and health beliefs and attitudes of patients and community members. Our study identified the importance of strong supportive communities on health worker motivation. These findings have implications for developing sustainable strategies for motivation and performance enhancement of rural health workers in resource poor settings.

Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza

BackgroundPrior to the availability of the specific pandemic vaccine, strategies to mitigate the impact of the disease typically involved antiviral treatment and “non-pharmaceutical” community interventions. However, compliance with these strategies is linked to risk perceptions, perceived severity and perceived effectiveness of the strategies. In 2010, we undertook a study to examine the knowledge, attitudes, risk perceptions, practices and barriers towards influenza and infection control strategies amongst domestic and international university students.MethodsA study using qualitative methods that incorporated 20 semi-structured interviews was undertaken with domestic and international undergraduate and postgraduate university students based at one university in Sydney, Australia. Participants were invited to discuss their perceptions of influenza (seasonal vs. pandemic) in terms of perceived severity and impact, and attitudes towards infection control measures including hand-washing and the use of social distancing, isolation or cough etiquette.ResultsWhile participants were generally knowledgeable about influenza transmission, they were unable to accurately define what ‘pandemic influenza’ meant. While avian flu or SARS were mistaken as examples of past pandemics, almost all participants were able to associate the recent “swine flu” situation as an example of a pandemic event. Not surprisingly, it was uncommon for participants to identify university students as being at risk of catching pandemic influenza. Amongst those interviewed, it was felt that ‘students’ were capable of fighting off any illness. The participant’s nominated hand washing as the most feasible and acceptable compared with social distancing and mask use.ConclusionsGiven the high levels of interaction that occurs in a university setting, it is really important that students are informed about disease transmission and about risk of infection. It may be necessary to emphasize that pandemic influenza could pose a real threat to them, that it is important to protect oneself from infection and that infection control measures can be effective.

Facilitators and barriers around teaching concepts of hand hygiene to undergraduate medical students

BACKGROUND Currently, there is limited literature examining the impact and appropriateness of the educational approaches used to teach medical students concepts around hand hygiene (HH). AIM To explore: (i) the perspectives of key academics and medical students towards HH and factors influencing compliance; (ii) the current teaching practices around HH in the medical school. We also aimed to examine options for new teaching and learning approaches to help improve student knowledge and attitudes towards HH. METHODS Individual, in-depth interviews were conducted with key academics and medical students. Transcripts were analysed thematically. FINDINGS Participants felt that students do not value the teaching around HH, nor do they find it interesting, especially in comparison to other subjects taught in the medical programme. The use of professional modelling, assessment tasks and feedback from patients and colleagues were the major educational recommendations; these could be implemented to help improve the attitudes of medical students towards HH and hopefully their compliance. Regular, small, group-scenario-based and/or practical hands-on sessions were also proposed. The need for a culture change was the overarching theme to foster sustainable HH practices among medical students. CONCLUSION Assessment and scenario-based learning and teaching approaches should be considered to help improve HH behaviours among medical students. Sustainability of these practices is likely to require role models and culture change around infection control.

“Nothing Special, Everything Is Maamuli”: Socio-Cultural and Family Practices Influencing the Perinatal Period in Urban India

Background Globally, India contributes the largest share in sheer numbers to the burden of maternal and infant under-nutrition, morbidity and mortality. A major gap in our knowledge is how socio-cultural practices and beliefs influence the perinatal period and thus perinatal outcomes, particularly in the rapidly growing urban setting. Methods and Findings Using data from a qualitative study in urban south India, including in-depth interviews with 36 women who had recently been through childbirth as well as observations of family life and clinic encounters, we explored the territory of familial, cultural and traditional practices and beliefs influencing women and their families through pregnancy, childbirth and infancy. We found that while there were some similarities in cultural practices to those described before in studies from low resource village settings, there are changing practices and ideas. Fertility concerns dominate women’s experience of married life; notions of gender preference and ideal family size are changing rapidly in response to the urban context; however inter-generational family pressures are still considerable. While a rich repertoire of cultural practices persists throughout the perinatal continuum, their existence is normalised and even underplayed. In terms of diet and nutrition, traditional messages including notions of ‘hot’ and ‘cold’ foods, are stronger than health messages; however breastfeeding is the cultural norm and the practice of delayed breastfeeding appears to be disappearing in this urban setting. Marriage, pregnancy and childbirth are so much part of the norm for women, that there is little expectation of individual choice in any of these major life events. Conclusions A greater understanding is needed of the dynamic factors shaping the perinatal period in urban India, including an acknowledgment of the health promoting as well as potentially harmful cultural practices and the critical role of the family. This will help plan culturally appropriate integrated perinatal health care.

Exploring the approaches used to teach concepts of hand hygiene to Australian medical students

Background: Recent audit data has revealed that the hand hygiene (HH) rates of Australian medical students is suboptimal. It has been suggested that new approaches are needed to teach students about infection control. As a first step, we undertook a study to determine the current educational approaches used to teach Australian medical students about HH. Secondly, this study aimed to explore the perceived barriers and to explore what other teaching approaches could be used to improve the levels of knowledge and compliance. Methods: A self-administered questionnaire was sent to the Dean of Medical Education at each of the medical schools in late 2012. Results: Of the 19 medical schools in Australia, 17 agreed to participate. The most commonly reported approaches currently used to teach students about HH are skills stations (17/17) and case scenarios/lectures (15/17). Clinical practical exams (15/17) and competency checks (11/17) are mostly used to assess the HH practices of medical students. Participants nominated the following as barriers to improving HH compliance: negative role modelling by senior doctors, and negative attitudes of students. Practical exercises (15/17), online teaching (12/17) and reflection (12/17) were suggested as other useful approaches that could be used to teach these concepts. Conclusion: Practical laboratory-based approaches were suggested as the most useful teaching and learning approach. Given the trend towards blended learning, universities may want to consider new HH teaching approaches that combine campus-based learning with online components and reflection. Early exposure and the continued reinforcement of HH concepts through the student’s medical degree are essential.

Understanding the meaning of youth sexual and reproductive well-being in Fiji

Abstract Well-being is a term commonly used in discussions of sexuality, reproduction and sexual health, yet the meaning of the term is elusive and often disregarded. As an example, the ‘well-being’ component of sexual and reproductive health and well-being is often not explicitly addressed in research, policy and programme development. The goal of this paper is to explore the meanings of sexual and reproductive well-being among young people in Fiji and their implications. Fourteen focus group discussions with young people aged 15 to 19 years and 40 key informant interviews were held in four Fijian settings. We found both different and shared meanings of sexual and reproductive well-being and suggest areas in which it can be strengthened in Fiji.

Inflated medicine prices in Vietnam: a qualitative study

One third of the worlds population lacks regular access to essential medicines partly because of the high cost of medicines. In Vietnam, the cost to patients of medicines was 47 times the international reference price for originator brands and 11 times the price for generic equivalents in the public sector. In this article, we report the results of a qualitative study conducted to identify the principal reasons for inflated medicine prices in Vietnam.Between April 2008 and December 2009, 29 semi-structured interviews were conducted with staff from pharmaceutical companies, private pharmacies, the Ministry of Health, and the Ministry of Finance of Vietnam. Study participants were recruited using a combination of purposive and snowball sampling techniques. Interviews were recorded, transcribed and coded using NVivo8® software and analyzed using a framework of structure-conduct-performance (SCP).Participants attributed high prices of originator medicines to a monopoly of supply. The prices of generic medicines were also considered to be excessive, reportedly due to the need to recoup the cost of financial inducements paid to prescribers and procurement officers. These inducements constituted a dominant cost component of the end price of generic medicines. Poor market intelligence about current world prices, as well as failure to achieve economies of scale because of unwarranted duplication in pharmaceutical production and distribution system were also factors contributing to high prices. This was reported to be further compounded by multiple layers in the supply chain and unregulated retail mark-ups.To address these problems a multifaceted approach is needed encompassing policy and legislative responses. Policy options include establishing effective monitoring of medicine quality assurance, procurement, distribution and use. Rationalization of the domestic pharmaceutical production and distribution system to achieve economies of scale is also required. Appropriate legal responses include collaborations with the justice and law enforcement sectors to enforce existing laws.

Development and appraisal of a hand hygiene teaching approach for medical students: a qualitative study

Background: Poor hand hygiene (HH) practices among medical students have previously been attributed to students not being exposed to sufficient teaching materials during their training. Aim: To develop and evaluate a teaching module directed at improving the knowledge and attitudes of undergraduate medical students towards HH. Methods: The HH teaching module was designed based on educational materials used by the World Health Organization and other patient safety organisations. The development was also informed by the findings from two previous studies including qualitative interviews with staff and students and a survey of Australian medical schools. In-depth group interviews were undertaken with 24 undergraduate medical students. Results: Favourable feedback was received from the interviewed medical students towards the developed scenario-based learning activity; however, the group interview activity was not received well by students. They suggested that the HH teaching activities should be compulsory and not optional for medical students. In order to reinforce good HH practices and to improve knowledge around HH and healthcare-associated infections, they felt that the activities should be repeated during each phase of their degree. Conclusions: There is a need to change the approach to training in education, particularly to engage students in topics such as HH which are often seen as unimportant.

We have to ask and only then do: Unpacking agency and autonomy in women's reproductive health in urban India.

ABSTRACT The limited autonomy and agency of women in developing countries is recognized as a key barrier to improving their reproductive health. Using an existing perinatal cohort in urban South India, we interviewed 36 women who had recently been through childbirth, and we carried out observations of family life and clinic encounters. Critical domains involved in womens agency and autonomy were womens participation in employment and group action and their mobility. Household decision making was considered a joint rather than individual responsibility. We call for a more nuanced understanding of these domains and their relationship to womens reproductive health, particularly for urban populations.

Eating soup with nails of pig: thematic synthesis of the qualitative literature on cultural practices and beliefs influencing perinatal nutrition in low and middle income countries

BackgroundThe perinatal period, i.e. pregnancy, childbirth and early infancy, is a significant transition period where the biological and the social strongly intersect. In low and middle-income countries the disease burden arising from the perinatal period, is still substantial. The perinatal period is also a crucial window of opportunity for reducing undernutrition and its long term adverse effects.MethodsWe explored qualitative research conducted in low resource settings around the perinatal continuum over the past two decades, with a particular focus on the ‘cultural’ realm, to identify common themes influencing maternal and infant nutrition. We systematically searched electronic databases from 1990 to 2014, including MEDLINE, EMBASE, PsycINFO, Scopus and Cumulative Index to Nursing and Allied Health Literature, using relevant search terms including traditional beliefs, practices, pregnancy, childbirth, developing countries etc. Adapted Consolidated Criteria for Reporting Qualitative Health Research and Critical Appraisal Skills Programme criteria were used to determine quality of studies. We synthesised the literature thematically, enabled by NVivo 10 software.ResultsMost studies showed cultural support for breastfeeding, although most traditional societies delayed breastfeeding due to colostrum being considered ‘dirty’. A range of restrictive practices through pregnancy and the post- partum period were revealed in Asia, Latin America and Africa. There was a strong cultural understanding of the healing power of everyday foods. A wide range of good foods and bad foods continued to have currency through the perinatal continuum, with little consensus between groups of what was beneficial versus harmful. Cross-cutting themes that emerged were 1) the role of the woman/mother/wife as strong and good; 2) poverty restricting women’s nutrition choices; 3) change being constant, but the direction of change unpredictable.ConclusionsA rich and diverse repertoire of cultural practices and beliefs influenced perinatal nutrition. Results from this synthesis should influence public health policymakers and practitioners, to tailor contextually specific, culturally responsive perinatal nutrition interventions to optimise health and wellbeing of mother-infant dyads. Ideally these interventions should build on culturally sanctioned life affirming behaviours such as breastfeeding, promoting post-partum rest and recovery, while modifying the potentially harmful aspects of other cultural practices in the perinatal period.